Scientists who have monitored numerous outbreaks of monkeypox in Africa say they are baffled by the disease’s recent spread in Europe and North America.
Cases of the smallpox-related disease have previously been seen only among people with links to central and West Africa.
However, in the past week, Britain, Spain, Portugal, Italy, the US, Sweden, Canada all reported infections, mostly in young men who had not previously traveled to Africa.
There are about 80 confirmed cases worldwide and 50 more suspected ones, the WHO said. France, Germany, Belgium and Australia reported their first cases on Friday.
“I’m stunned by this. Every day I wake up and there are more countries infected,” said Oyewale Tomori, a virologist who formerly headed the Nigerian Academy of Science and who sits on several WHO advisory boards.
“This is not the kind of spread we’ve seen in West Africa, so there may be something new happening in the West,” he said.
To date, no one has died in the outbreak. Monkeypox typically causes fever, chills, rash and lesions on the face or genitals. The WHO estimates the disease is fatal for up to one in 10 people, but smallpox vaccines are protective and some antiviral drugs are being developed.
British health officials are exploring whether the disease is being sexually transmitted. Health officials have asked doctors and nurses to be on alert for potential cases, but said the risk to the general population is low.
The European Center for Disease Control and Prevention recommended all suspected cases be isolated and that high-risk contacts be offered smallpox vaccine.
Nigeria reports about 3,000 monkeypox cases a year, the WHO said. Outbreaks are usually in rural areas, when people have close contact with infected rats and squirrels, Tomori said.
He said many cases are likely missed.
Ifedayo Adetifa, director-general of Nigeria’s Center for Disease Control, said none of the Nigerian contacts of the British patients have developed symptoms and that investigations were ongoing.
The WHO’s Europe director, Hans Kluge, described the outbreak as “atypical,” saying the disease’s appearance in so many countries across the continent suggested that “transmission has been ongoing for some time.”
He said most of the European cases are mild.
On Friday, the British Health Security Agency reported 11 new monkeypox cases, saying “a notable proportion” of the infections in the UK and Europe have been in young men with no history of travel to Africa and who were gay, bisexual or had sex with men.
Authorities in Spain and Portugal also said their cases were in young men who mostly had sex with other men and said those cases were picked up when the men turned up with lesions at sexual health clinics.
Experts have said they do not know if the disease is being spread through sex or other close contact related to sex.
Nigeria has not seen sexual transmission, Tomori said, but he added that viruses that had not initially been known to transmit via sex, like Ebola, were later proven to do so after bigger epidemics showed different patterns of spread.
The same could be true of monkeypox, Tomori said.
Germany Minister of Health Karl Lauterbach said the government was confident the outbreak could be contained.
He said the virus was being sequenced to see if there were any genetic changes that might have made it more infectious.
Rolf Gustafson, an infectious diseases professor, told Swedish broadcaster SVT that it was “very difficult” to imagine the situation might worsen.
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